Diabetic Ketoacidosis

Classical Triad in DKA
1. Hyperglycemia
2. Ketosis
3. Acidosis
Etiology
1. Type I Diabetes Mellitus
2. Type II Diabetes Melitus with other Illness
3. Insulin omission
4. Infection
5. Dehydration owing to illness with vomiting and diarrhea
6. Change in diet, insulin, or exercise regimen
7. Intra-abdominal process (cholecystitis, pancreatitis)
Clinical Manifestations
1. Polyuria
2. Polydipsia
3. Polyphagia
4. Dry mouth
5. Abdominal pain
6. Nausea and vomiting
7. Level of Conscussioness : gradually increasing restless, confusion, lethargy
8. Flushed, dry skin
9. Eyes appear sunken
10. Fruity breath
11. Kussmaul's respiration
12. Pulse: rapid, weak
13. Orthostatic hypotension
14. Oral or vaginal Candida albicans
15. Dehydrations
16. Fatigue
Laboratory Findings
1. Serum
  1. Increased Blood Glucose level (BC)>14mmol/mL
  2. Decreased Na
  3. Decreased HCO3
  4. Increased BUN
  5. Increased creatinine
  6. Ketonemia
  7. Decreased PO4
  8. Increased osomolity
  9. Increased Potassium
2. ABG
  1. Metabolic acidosis (arterial blood pH below 7.35)
3. Urine
  1. Glucosuria
  2. Ketonuria
Nursing Interventions
1. Initial
  1. Ensue patent airway
  2. Administer oxygen as per physician's order
  3. Establish IV access with large-bore catheter
  4. Fluid resuscitation 0.9% NaCL solution: until BP satblized and urine output 30-60mL/hr
  5. Insulin therapy
    1. Initially load: 0.1U/kg/body weight (IV regular insulin bolus)
    2. Maintenance: 0.1 unit/kg/hr as needed (regular insulin drip)
  6. IV Potassium replacement: to correct hypokalmia
  7. IV Sodium bicarbonate if sever acidosis (pH<7.0)
  8. Identify history of:diabetes, time of last food, time and amount of last insulin infection
2. Ongoing Monitoring
  1. Vital signs
  2. Level of consciousness Glasgow Coma Scale every 1-2h
  3. ECG
  4. Oxygen saturation
  5. Urine output
  6. Assess breath sounds for fluid overload
  7. Monitor Levels
    1. Glucose
    2. pH
    3. Electrolytes
    4. Bicarbonates
    5. Blood Gases
Patient Education
1. Diabetic education
2. Blood glucose monitoring
3. Identification of precipitating factors
4. Home monitoring of ketones
5. Supplemental short-acting insulin regimens
6. Easily digestible liquid diets when sick
7. Guidelines for when patients should seek medical attention
8. Special education for patients on pump management
9. Check Insulin device working properly
10. Use Insulin per Prescriptions Schedule
Complications
1. Shock
2. Vascular thrombosis
3. Pulmonary Edema
4. Cerebral edema
5. Hypovolemia
6. Renal Failure
7. Dehydration

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Diabetic Ketoacidosis

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	Created by Olena Frolova almost 6 years ago